The change of attitudes towards organ donation in Hong Kong

Abstract

Background: Organ transplantation is getting more important and the demand increased exponentially in the past decade. However, due to the shortage of organ supply, some people died while waiting for an organ and the other may rely on all forms of organ support to live.

Hong Kong has the lowest organ donation rate among the developed world despite large-scale organ donation enhancement activities implemented for decade. Since consent from family members is mandatory, it is important to understand the reasons relatives given for consenting or refusing to donation.

Objectives: (1) To investigate the change of attitudes towards organ donation in Hong Kong during 2004 to 2012. (2) To understand the difficulties of transplant coordinators encountered during counseling

Methods: This is a cross-sectional survey looking at the recent change of reasons of the families of the potential donors to make decision about donation. Transplant coordinators of all 7 clusters completed questionnaires after counseling each potential donor referred during the 7 months study period. Demographic data and reasons of refusal or consent of donation were recorded and analyzed and compared with previous results. Difficulties of transplant coordinators encountered during counseling were recorded.

Results: Totally 52 questionnaires were completed within 7 months. The conversion rate were similar when compared to that in 2004 (44.3% in 2004 vs 40% in 2012). The proportion of older potential donor in the refusal group is higher than that of consent group (> 60 years old 51.6% vs 38%,). The demographic data was neither statistical significantly different between consent and refusal group nor correlated with refusal of donation.

From 2004 to this survey, the most common reason to refusal remained to be the traditional belief of buried intact. Both were 33%. The “expressed wish of the deceased to object donation while alive” increased from 13% in 2004 to 20% in 2012 (p=0.378), and “no consensus from family” dropped from 26% in 2004 to 11% in 2012 (p=0.083). The reason “no expression of any wish” remained static when compared to that in 2004 (15% vs 16%, p=0.982).

The reason for consenting to donation changed a lot. Although the most common reason remained the “wish to help others” (94% vs 41%, p<0.0001), the second and third reason changed to “feeling good by being charitable” (21% vs 0%, p=0.0071) and “not to waste useful organs” (18% vs 3%, p=0.0455) while the fourth reason was “respect deceased’s choice”(14% vs 0%, p=0.0278). The reasons of refusal and consenting donation are explained in the context of the decision-making process. The main obstacles the transplant coordinators have encountered were knowledge gap, emotion, time pressure and family or social disharmony.

Conclusion: The major reasons for consenting and refusing donation did not only change in position but also change in proportion in last decade. The importance of some reasons increased significantly and strategies to improve conversion rate should be adjusted according to the changing reasons. Education to change the traditional belief, encourage expression of donation wish, create position image of donation and the benefit of transplant are all important.